Manual Registration Form - Future Stars Soccer Camps

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Manual Registration Form - Future Stars Soccer Camps
Manual Registration Form
Mail / Fax / Scan this registration form with payment and consent form
Future Stars Soccer Academy, Inc.
Camp Location Oglethorpe University
3000 Woodrow Way, Atlanta, GA 30319
www.FSSoccerCamps.com
Please check off your camp week(s)
June 15-19, 2015
July 6-10, 2015
Camp 1 Half-Day Camp
Ages 4-6
Camp 1 Full Camp
Ages 7-18 $310.00 9am-3:30pm $155.00
9am-11:45am
July 13- 17, 2015
$155.00 9am-11:45am
Camp 3 Full Camp
$310.00 9am-3:30pm
Ages 7-18
Ages 4-6
$155.00
9am-11:45am
Camp 2 Full Camp
Ages 7-18 $310.00 9am-3:30pm
Before and After Care for the week
Camp 3 Half-Day Camp Ages 4-6
Camp 2 Half-Day Camp
All-Day Camps drop off 8:00am / pick up 5:00pm
$80.00 for the whole week (NO pro-rated days)
Please check off your camp group
Half Day Minions ages 4-6
Mini Pro ages 7-9
Junior-Pro ages 10-13
Senior-Pro ages 14+
Whole Teams-email first
Please print CLEARLY
Players’ Last Name: __________________________________________ First Name: _____________________________________
Address: _____________________________ City: ___________________State: ______ Zip: ____________ Country: __________
Email One: __________________________________________ Email Two ____________________________________________
Email Three: _________________________________________ Email Four ____________________________________________
Home Phone: ____________________________ Phone 2: ________________________ Phone 3: __________________________
Age (At the time of camp): ______ Date of Birth: _______________ School: _______________ Gender:
Position:
Field Player
Goalkeeper
Male or
Female
Jersey Size:_______________________
Team name: ___________________________ Playing Level (e.g., Classic, Challenge, Athena, Rec):__________________________
How did you hear about us? _______________________________ What School do you attend? __________________________
Please complete one registration form for each player. Send payment or $200 deposit for each week of camp to reserve your
child’s spot. ($100 deposit for half day.)
Payment Information
Payment (or deposit) amount: US $ __________________
Check | Credit Card:
Visa
MasterCard
Discover
AmEx
Cardholder Name: _______________________________________________________________ (As it appears on credit card)
Credit Card Number: _____________________________________________________ Expiration Date: _____________________
Validation CVV: _________________
Cardholder Address (if different from player) ____________________________________________________________________
Your credit card will be charged to hold your spot the day you sign-up. The balance will be charged on June 5, 2015.
I agree to the above terms. Signed: __________________________________________
Date: __________________________
Did you know?
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Lunch is catered Monday – Thursday for all day campers. They are seated in an air-conditioned building to eat and rest before next session.
Payment plans are available for all camps. Your credit cards will automatically be charged the day you sign up and the balance will be charged on June 5, 2015.
Future Stars Soccer Academy has an outdoor blow up soccer pitch referred to as the WALL to WALL. Campers learn quick thinking of the game.
If bad weather is in the area, campers will be taken to the gym of Oglethorpe University.
Communication to our campers will be through email. Please be sure to add all the email accounts you would like notified.
You now can register online at www.FSSoccerCamps.com. Click for Camp1: June 15-19, 2015, Click for Camp2: July 6-10, 2015, Click for Camp3: July 13-17, 2015
Questions / Help Line: (678) 664-9604 • [email protected]
FUTURE STARS SOCCER ACADEMY 3000 Woodrow Way #628, Atlanta, GA 30319 • tel (678) 664-9604 • fax (404) 364-8445 • Tax ID # 05-0555940
Consent Manual Registration Form
Mail / Fax / Scan this registration form with payment and consent form
Future Stars Soccer Academy, Inc.
Camp Location Oglethorpe University
3000 Woodrow Way, Atlanta, GA 30319
www.FSSoccerCamps.com
Please print CLEARLY
Players’ Last Name: _________________________________________ First Name: ______________________________________
Address: __________________________________ City: _______________State: ______ Zip: ___________ Country: __________
Age (at the time of camp): ___________
Date of Birth: _______________
Gender:
Male or
Female
Any medical concerns the coach needs to know? _________________________________________________________________
Do you have any food allergies? If so, please provide details: _______________________________________________________
__________________________________________________________________________________________________________
Insurance Company _______________________ Policy Holder ______________________ Policy Number ___________________
Player’s Doctor ____________________________________ Doctor’s Phone Number ___________________________________
Medical Release
I the Parent/Guardian hereby give permission for any and all medical attention to be administered to my child in the event of
accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be contacted. I also
assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the
date given below. In case I cannot be reached, any of the following persons is designated to act on my behalf: · Any Academy
representative or camp representative where my child is playing, participating in a tournament, or attending a clinic or camp; or ·
My child’s physician or a one selected by the Academy to hospitalize or secure medical.
Liability
I assume all risk of loss or property or injury to the person, including injuries resulting in death caused by or incidental to dangers
associated with soccer activities and agree that there are certain inherent dangers related to soccer participation and therefore
agree to indemnify, hold harmless and, upon the reasonable request of Academy, to defend Future Stars Soccer Academy, Inc,
and its employees, directors, officers, agents, and volunteers from and against all loss, liability, damages, claims, or expenses,
including reasonable attorneys’ fees, arising out of claims or suits for damage or injury to persons or property in connection with,
in whole or in part, for any injury which might be considered a normal risk associated with participation in or attendance at any
soccer activity.
Release Photo Comments
I give Future Stars Soccer Academy permission to use content (e.g.,photography, video, film, oral and written evaluations or
feedback) and other identifying information contained within (e.g.,names, images, and comments of self, spouse, and child), in
whole or in part, in marketing activities relating to the promotion of the Academy. Academy may record by any means including,
without limitation, electronic recording, film,videotape, audiotape, and/or photography. Academy will own all copyrights and
grants parent/guardian a license to use the content. However, both parties agree to stop using the content within sixty days
upon written request from the other. Academy will have the right to use, reference and display as follows: (i) by publication on
Academy’s websites; (ii) by publication in any and all media now or hereafter known, including, without limitation, television,
cable, satellite transmission, film, videotapes, motion pictures, audio recordings, photographs, print publications, merchandising,
the Internet and World Wide Web; (iii) in printed and videotaped copies distributed to Academy employees prospects, and
customers or distributed at Academy-sponsored or co-sponsored events; (iv) in excerpts included in speeches, slides, brochures
and other marketing collateral materials; and (v) as reference when communicating with prospective customers, the press and
the general public. I agree to release the Academy and its contractors, agents, and employees, from any claims, so long as such
use is in accordance with the rights granted under this release.
Lunch Details
Full-Day campers are provided a catered healthy lunch Monday - Thursday. The campers will eat in an air-conditioned room
during lunchtime. Half-Day Campers are to bring their own snack. Water will be available for all campers.
No Refund Policy
Future Stars Soccer Academy, Inc. follows a NO REFUND policy. Paid fees may, however, be credited to a future camp.
Guardian Signature: ___________________________________________
Date: ______________________________________
Questions / Help Line: (678) 664-9604 • [email protected]
FUTURE STARS SOCCER ACADEMY 3000 Woodrow Way #628, Atlanta, GA 30319 • tel (678) 664-9604 • fax (404) 364-8445 • Tax ID # 05-0555940